Stranded on the rocks: “unmet treatment need” amongst people who use crack cocaine in a town in Northern England

Since 2014, England has seen a steady increase in the number of people who use crack cocaine in the community. Increasing access to care-planned psychosocial drug treatment, which prioritizes the cessation of all drug use, has been a key policy response. Within this context, we present the first qualitative exploration of the needs of out-of-treatment people who use crack in England. We conducted 36 semi-structured interviews with people who use crack who had not engaged in structured’ treatment for at least a year in a Northern English town (‘Northton’). Participants described Northton as suffused with violent and visible crack markets. Most were street homeless, highly stigmatized, and with little access to legitimate income. Very few could imagine how drug treatment might help their situation. The participants emphasized the limited appeal of intensive psychosocial drug treatment focused on stopping all drug use. With extensive evidence highlighting the lack of any ‘gold standard’ intervention for crack, we call for a reorientation of drug policy to prioritize the self-described basic and survival needs of people who use drugs. Low-threshold offers of food and pragmatic support appear invaluable. Environmental interventions to reduce crack availability and associated violence are also essential.